Abstract

Glenoid and humeral head bone loss is the most common cause of failure after surgical shoulder instability stabilization. Large Hill-Sachs lesions involving >30% of the articular surface of the humeral head typically occur after neglected or locked shoulder dislocations. Such large lesions may require osteochondral allograft reconstruction or prosthetic replacement to regain shoulder stability and function.Previous reports of osteochondral allograft reconstruction have focused on adults. This article describes a case of a 16-year-old autistic boy who sustained an anterior dislocation of the right shoulder following a seizure episode. The dislocation was diagnosed 12 days later as a progressive deformity, and his parents noticed his inability to use his upper extremity. The patient had a large (30%) humeral head Hill-Sachs lesion and persistent anterior shoulder instability after initial closed reduction. He underwent an open osteochondral allograft reconstruction for the restoration of the humeral head articular surface. The sizing of the defect, matching harvest of the allograft, and perfect fit of the allograft to the defect are critical steps to ensure congruent restoration of the humeral head. The allograft was stabilized in the defect of the humeral head using cancellous screws placed from below the articular surface. Radiographs 20 months postoperatively showed complete incorporation of the osteochondral allograft. At 30 months postoperatively, his shoulder was stable and functional.

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Authors

Nathan ST, Parikh SN

Institution

Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229-3039, USA.

Source

Orthopedics 35:5 2012 May pg e744-7

MeSH

Adolescent
Arthroscopy
Bone Transplantation
Humans
Humeral Head
Joint Instability
Male
Osseointegration
Reconstructive Surgical Procedures
Recovery of Function
Shoulder Dislocation
Shoulder Joint
Treatment Outcome

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22588420